Liver Transplantation in HIV-Positive Patients

• Published in: Transplantation proceedings 2007-07, Vol.39 (6), p.1936-1938
• Main Authors: Vennarecci, G, Ettorre, G.M, Antonini, M, Santoro, R, Perracchio, L, Visco, G, Santoro, E
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - epidemiology; HIV Infections - complications; HIV Infections - mortality; HIV Seronegativity; HIV-1; Human viral diseases; Humans; Incidence; Infectious diseases; Liver Failure - complications; Liver Failure - surgery; Liver Failure - virology; Liver Transplantation - mortality; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Patient Selection; Retrospective Studies; RNA, Viral - isolation & purification; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Tissue, organ and graft immunology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2007.05.076

Abstract Aims The aim of this study was to evaluate the feasibility of liver transplantation ( OLT ) in human immunodeficiency virus (HIV), hepatitis C virus (HCV) coinfected patients in Italy. Methods Between September 2002 and April 2006, 12 HIV+ coinfected patients (11 men, mean age 42 years) underwent OLT at our Institute. Eleven (91%) patients were HCV-positive and one was hepatitis B virus-positive. Pre-OLT plasma HIV 1-RNA level was undetectable and CD4+ T-cell count >200 cells/μL for 3 months in all patients. Six patients had to stop highly active antiretroviral therapy (HAART) before OLT because of liver disease severity (n = 2) and for hepato cellular carcinoma (n = 4). Results The actuarial 1-, 2-, and 3-year survival rates were 83.3%, 58.3%, and 58.3%, respectively, which were significantly lower than those observed among HIV-negative patients transplanted in our center. Six patients are alive with a mean follow-up of 26 months (range: 5 to 46 months). We recorded a low rate of opportunistic infections and rejection. All alive patients have low levels of HIV RNA, and the CD4+ T-cell counts increased after OLT. Nine patients developed early recurrence of hepatitis C requiring combination therapy with peg-interferon plus ribavirin. Significant improvement in the quality of life was observed in 7/11 patients. Conclusions OLT in HIV-positive patients was feasible with good results in the short and medium term. Early severe HCV recurrence may be observed. Key challenges for the management of HIV+ patients after transplantation included treatment of severe HCV recurrence and attention to the pharmacological interactions of HAART with immunosuppressive drugs.